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* Indicates required question
Email
*
Your email
Name
*
Your answer
Other persons living in household
Your answer
Do you have children under 18 living at home?
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Yes
No
Current Address
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Your answer
Contact phone #
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Your answer
Are you currently employed? If so, describe where and hours worked weekly?.
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Your answer
Have you contacted your township trustee about this need?
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Yes
No
Have you been served by programs offered by Associated Churches (https://www.associatedchurches.org) or Inasmuch Ministries (https://inasmuchfw.org)?
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Yes
No
Have you ever attended worship at St. Joe UMC or St. Joe @ Y? If so, when?
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Your answer
Have any children in the home participated in Level-Up, St. Joe Youth Group or Faith in Motion?
Your answer
Are you an employee of the Jackson R Lehman YMCA? (We hold this information in confidence as well and will not share your request with the staff of JRL YMCA, but do desire to know confidentially when and to what extent our efforts aid in the support of our institutional partner).
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Yes
No
Other:
What would you describe as your most pressing need for assistance? (Rent assistance, utility assistance, clothing, food, or other)
*
Your answer
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